Service | Billing code |
Payer and amount |
Description |
---|---|---|---|
CPT |
Medicaid $3 |
|
|
G0442 | Medicare $17 |
|
|
G0443 | Medicare $24 |
|
|
G2011 | Medicare $16 |
|
|
CPT 99408 |
Medicaid $23-27 |
|
|
G0396 | Medicare $33-35 |
||
CPT 99409 |
Medicaid $47-53 |
|
|
G0397 | Medicare $64-66 |
Notes:
Not all codes are approved for use in all states. CPT codes above should be appended to E/M service with modifier 25. Payment amounts are estimates only.
ICD-10 diagnosis codes are poorly suited for most SBIRT patient scenarios, and may break confidentiality with adolescent patients when parents read billing documents. Sometimes Z13.89 (“Encounter for screening for other disorder” or Z13.9 (“Encounter for screening, unspecified”) is used.
Screening tools approved by the Oregon Health Authority (Medicaid) for reimbursement are listed here. Note that the Brief screen (single alcohol and drug questions) is not reimbursable.
Independent billing:
Only the following licensed professionals are allowed to bill the above codes independently:
- Oregon Medicaid:
-
- Physicians
- Physician Assistants
- Nurse Practitioners
- Licensed Clinical Psychologists
- Licensed Clinical Social Workers
- Licensed Professional Counselors
- Licensed Marriage and Family Therapists
- Medicare:
-
- Physicians (MD, DO only)
- Physician Assistants
- Nurse Practitioners
- Licensed Clinical Psychologists
- Licensed Clinical Social Workers
- Certified Nurse Midwives
- Clinical Nurse Specialists
Incident-to billing under Oregon Medicaid:
Under Oregon Medicaid, any clinic employee or contractor acting under the supervision of a licensed and credentialed provider may be able to receive reimbursement for screening and brief intervention services, under incident-to rules. Examples of these individuals include (not an exhaustive list):
- Certified alcohol and drug counselors (CADCs), medical assistants, nurses, health educators, community health workers, wellness coaches, students or graduates entering medical professions.
Incident-to billing rules may not apply towards all SBIRT workflows or settings. It is best to check with a billing specialist beforehand for guidance. Medicaid rules are subject to change, and providers should follow Oregon's Administrative Rules as it relates to Medicaid billing guidelines.